A silent epidemic haunting the Jammu & Kashmir’s elderly
Govind Sharma
sharmaexcelsior@gmail.com
Jammu and Kashmir has emerged as the state with the highest prevalence of dementia in India-11.04 percent among people over 60 years-according to a landmark nationwide study published in “Alzheimer’s & Dementia”, the journal of the Alzheimer’s Association.
This figure is significantly higher than the national average of 7.4 percent, placing the region at the center of a looming public health challenge that is only expected to intensify as India’s population ages. In contrast, Delhi records the lowest rate at 4.5 percent. Jammu and Kashmir stands apart, with nearly one in every ten elderly residents affected.
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder that causes memory loss and impairment of multiple cognitive abilities, including deterioration in language, learning, visual-spatial skills, reasoning, and behaviour. The decline in cognitive abilities over time becomes severe enough to interfere with activities of daily living. It is the most prevalent form of dementia, contributing to at least two-thirds of dementia cases among individuals aged 65 and older. Early-onset AD has an age of onset younger than 65 years. By 2050, it is estimated that AD will affect more than 100 million people worldwide. Thus, the World Health Organization (WHO) has categorized it as a public health priority. In India, the estimated prevalence of dementia among individuals aged 60 and older is 7.4%.
Contrasting Regional Findings within J&K
Interestingly, local studies have revealed striking variations within the state itself. A 2010 survey on the ethnic Dogra population of Jammu district found a comparatively low dementia prevalence of 1.83 percent, far below the national average. However, earlier research on Kashmiri migrant populations living in camps around Jammu revealed much higher rates-6.55 percent among those above 60 years.
Researchers attribute these disparities to factors such as migration stress, conflict exposure, lifestyle changes, and genetic predispositions. The findings underline that while dementia rates can remain low in certain settled populations, upheaval and chronic stress may significantly accelerate cognitive decline.
Clinical Manifestations of Alzheimer’s Disease
According to Dr Anupama Shah, Assistant Professor in the Neurology Department of Government Medical College (GMC) Jammu, AD is a chronic condition that develops silently, with neurodegenerative changes in the brain continuing for over a decade before overt symptoms appear. Currently, three stages of the disease are described-preclinical AD, Mild Cognitive Impairment (MCI) due to AD, and dementia.
Dr Shah explains that as the disease progresses, the decline in cognitive functions becomes increasingly significant and noticeable. Symptoms include memory loss, confusion, and behavioural changes accompanied by depression, personality alterations, and apathy. Episodic short-term memory loss is the initial and most common presenting symptom. Patients often struggle to retain new information while retaining long-term memories. Difficulties with problem-solving, judgment, executive functioning, and organizational skills typically follow. Tasks requiring multitasking and abstract thinking become challenging. Instrumental activities of daily living-such as driving, financial management, cooking, and detailed planning-are affected relatively early. As the condition advances, language and visuospatial difficulties impair communication and often result in wandering.
Neuropsychiatric symptoms may include apathy, social withdrawal, disinhibition, agitation, psychosis, and sleep disturbances. Eventually, patients may become mute and unresponsive to verbal requests, develop swallowing difficulties, incontinence, impaired self-care, and total dependence on caregivers.
Risk Factors
As per Dr Shah, advancing age is the single most significant risk factor associated with AD, with prevalence approximately doubling every five years after the age of 65. Female sex, lower educational level, and rural residence are associated with higher prevalence. Air pollution, impaired hearing, and visual loss also contribute.
Cardiovascular disease (CVD), stroke, obesity, and diabetes are major modifiable risk factors. Other potential contributors include stress and trauma, head injury, adverse life events, depression, higher parental age at birth, smoking, and family history of dementia. Genetic factors play a role in both early- and late-onset AD. Having a first-degree relative with AD increases the risk by 10% to 30%. Individuals with two or more siblings with late-onset AD face a threefold higher risk than the general population.
Diagnosis and Whom to Contact
Dr Hardeep Kumar, Consultant Neurologist at Super Speciality Hospital (SSH) Jammu, stresses that there is no single test to detect Alzheimer’s disease. Diagnosis requires a complete medical examination, including mental status and cognitive testing, alongside blood tests and brain imaging. Diagnostic biomarkers are also being increasingly used, mainly in research settings.
He emphasizes the importance of early consultation. Families noticing worrying signs should seek medical help from neurologists or psychiatrists. “Early detection allows us to rule out other treatable causes of memory loss, such as depression or vitamin deficiencies, and to begin management sooner,” says Dr Hardeep.
Treatment and Management
According to Dr Hardeep, patients with Alzheimer’s require not only medication but also significant non-pharmacological rehabilitation in the form of caregiving-primarily provided by family members in India. Currently, therapies for AD are largely symptomatic and do not alter disease progression. Approved drugs, such as cholinesterase inhibitors (Donepezil, Rivastigmine) and partial NMDA antagonists (Memantine), modulate neurotransmitters like acetylcholine and glutamate.
Recently, amyloid-directed antibodies such as donanemab and lecanemab have been approved as potentially disease-modifying therapies. However, they are not yet widely available in the Indian market. Secondary symptoms of AD-such as depression, agitation, aggression, hallucinations, delusions, and sleep disorders-often require psychotropic medication. Behavioural symptoms are common and can exacerbate cognitive and functional decline. Behavioural therapy may help in mild to moderate disease.
Prevention
The greatest window of opportunity lies in the prolonged preclinical phase, where modifiable risk factors can be addressed. Dr Shah stresses the need to sensitize people to early, seemingly trivial behavioural changes, which should not be dismissed as mere age-related decline. Preventive strategies must focus on early and sustained lifestyle interventions across the life course.
Specific actions to reduce dementia risk:
Early life: Ensure good quality education, use protective headgear, avoid excessive noise exposure, prioritize healthy diet, and promote family interactions.
Midlife: Engage in activities enhancing cognitive reserve, participate in community/ group activities, quit smoking, limit alcohol, seek help for depression, screen and address hearing/ visual loss, maintain systolic blood pressure below 130 mmHg from age 40, treat high LDL cholesterol and diabetes, and maintain healthy weight.
In addition, community initiatives and public health policies must focus on supportive care and easing caregiver burden-a pressing issue often ignored in Indian society but impossible to overlook any longer.
The Road Ahead
Globally, more than 55 million people live with dementia, a figure projected to triple to 139 million by 2050. India’s dementia cases are expected to double to 17 million by 2036, with Jammu and Kashmir disproportionately affected.
The Dogra and Kashmiri migrant studies, alongside the nationwide “Alzheimer’s & Dementia” report, demonstrate that dementia is not evenly distributed-even within a single state. This underscores the urgent need for region-specific health planning, awareness campaigns, and caregiver support systems. Unless addressed now, Alzheimer’s disease will not only challenge patients but also strain families, communities, and the healthcare system.
IMPORTANT TO KNOW
* “Nearly one in every ten elderly residents of Jammu & Kashmir is living with dementia.”
* “Alzheimer’s begins silently, often a decade before the first symptoms appear.”
*”Caregiving in India is largely a family responsibility-an invisible burden we can no longer ignore.”
* “Prevention must begin early: the earlier and longer we control risk factors, the better.”
Spot the Early Signs
* Forgetting recent conversations or events
* Struggling with familiar tasks (e.g., cooking, finances)
* Losing track of time/place
* Personality or mood changes
* Wandering away from home
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